Hemodynamic improvement using methylene blue after calcium channel blocker overdose

doi:10.5847/wjem.j.1920-8642.2019.01.009

Abstract

Sophia Ahmed, Stacey Barnes. Hemodynamic improvement using methylene blue after calcium channel blocker overdose[J]. World Journal of Emergency Medicine, 2019, 10(1): 55-58.

Figures/Tables 1

Table 1

The use of and timing of various interventions in previous case reports

Reference	Age/gender	Clinical presentation	Time to treatment	Interventions prior to methylene blue	Outcome
3	61-year-old/male	Alert and oriented, stable vital signs	Known overdose several hours prior to arrival	Calcium gluconate, glucagon, fluids, pressors, high-dose insulin, fat emlusion therapy, continuous veno-venous hemodialysis. Methyelene blue was started 40 hours after initial presentation.	Survival
5	69-year-old/female	Somnolent, vomiting, hypotensive and minimally responsive	Known overdose 5 hours prior to arrival	Fluids, glucagon, calcium chloride, pressors, dextrose-insulin drip. Methylene blue was started 11 hours after initial presentation.	Survival
6	25-year-old/female	Alert and oriented, tachycardic	Known overdose 1 hour prior to arrival	Activated charcoal, fluids, calcium gluconate, glucagon, pressors, high-dose insulin-euglyceia therapy. Methylene blue was started 16 hours after initial presentation.	Survival
7	41-year-old/male	Comatose, intubated, hypotensive	Known overdose 2 hours prior to arrival	Activated charcoal, fluids, pressors. Methylene blue was started 12 hours after initial presentation.	Survival
8	60-year-old/female	Alert and oriented, vomiting, hypotensive	Known overdose 10 hours prior to arrival	Fluids, pressors, glucagon, sodium bicarbonate, calcium carbonate, methylprednisolone, insulin. Methylene blue was started within 18 hours of initial presentation.	Survival
9	53-year-old/male	Alert and oriented, stable vital signs	Not disclosed	Fluids, calcium gluconate, glucagon, pressors, lipid emulsion therapy, hyuperinsulinemic euglycemic therapy. Methylene blue was started approximately 9 hours after initial presentation.	Expired
10	62-year-old/male	Vomiting, hypotensive	Known overdose within 24 hours prior to arrival	Fluids, pressors, insulin, antibiotics. Methylene blue was started 4 hours after initial presentation.	Survival
11	15-year-old/male	Altered, hypotensive, tachycardic	Known overdose 1.5 hours prior to arrival	Fluids, calcium glucontate, activated charcoal, pressors. Methylene blue was started 6.5 hours post-ingestion.	Survival
12	58-year-old/female	Alert and oriented, hypotensive, tachycardic	Known overdose 2 hours prior to arrival	Fluids, calcium, pressors, hyperinsulinemia-euglycemia therapy, lipid emulsion, continuous venovenous hemofiltration. Methylene blue was started within 24 hours after initial presentation. Molecular Adsorbent Recirculating System therapy started thereafter.	Survival
13	50-year-old/male	Alert and oriented, Tachycardic	Not disclosed	Fluids, pressors, calcium gluconate, glucagon, hyperinsulinemia-euglycemia therapy, fat emulsion. Methylene blue was started less than 19 hours after initial presentation. VA-ECMO started thereafter.	Survival

Table 1

References 14

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Hemodynamic improvement using methylene blue after calcium channel blocker overdose

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